March 8, 2020

10 Questions to Ask a New Therapist

10 Questions to Ask a New Therapist

Finding the right therapist can be challenging, scary, and frustrating. The process of getting connected to therapy involves complicated information about insurance, long wait times, as well as the anxiety of being vulnerable with a complete stranger. Although you may be tempted to settle in with the first provider with whom you meet, it is very important to ensure that this provider is the correct fit. 

The importance of therapeutic fit goes far beyond comfort or enjoyment related to this process – it actually plays a large role in treatment outcome. 

The Importance of the Therapeutic Alliance

“Therapeutic alliance” is a term used to describe the working relationship between the patient and therapist. Multiple research studies have demonstrated that this variable is strongly associated with treatment outcome, regardless of the patient’s diagnosis or the therapeutic orientation. Therefore, it could be suggested that this is the most important factor to consider when looking for a therapist.The following ten questions serve to help you determine if this provider is a good fit, while also giving you important information about what to expect throughout the process of therapy.

1. Do you have a license to provide treatment for mental health concerns?

Ensuring that your provider has a license is incredibly important, as this certifies that the individual has the appropriate education, training, and experience to effectively provide clinical services. Additionally, in order to maintain a license, the provider must be in good standing with their governing board’s code of ethics. Requiring mental health professionals to have a license is a way to protect the general public from receiving services that are damaging or unethical; therefore, it is important to ensure your therapist has one.

That being said, navigating licensure within the field of mental health field can be quite confusing, as there are multiple types of licenses that enable a professional to deliver clinical services.

You may see letters including, but not limited to:

  • LP (licensed psychologist)
  • LCSW (licensed clinical social worker)
  • LPC (licensed professional counselor)
  • LMHC (licensed mental health counselor)
  • LMFT (licensed marriage and family therapist)
  • LCADAC (licensed clinical alcohol and drug abuse counselor)

If you come across letters that you don’t recognize, we recommend that you ask your provider about their license and the governing board.

2. Have you worked with individuals that are experiencing similar concerns?

Although a license provides assurance that the professional can provide clinical services, it is important to ensure that this individual has experience that is consistent with your presenting concerns and therapeutic goals. 

This question may be less relevant for individuals looking for support related to depression, anxiety, or relationship concerns, as these are fairly commonly seen within clinical practice. However, if you are looking for something more specific such as treatment addressing insomnia, obsessive-compulsive disorder, or substance-use disorders, it is recommended that you ensure your provider has experience with that population. 

Fortunately, professionals are mandated by their code of ethics to remain within their realm of competence; therefore, providers should comment on whether they can help you or if you would be better served by a different provider. If your therapist has not mentioned this, we recommend that you ask this question.

3. What type of approach do you usually use and is it evidence-based?

There are a variety of evidence-based approaches that can treat the same mental health disorder. Additionally, depending on one’s education, training, experience, and professional identity/style, they may be more likely to use one style over another. 

For example, someone who uses a psychodynamic framework may be more likely to focus on one’s past and family dynamics. Alternatively, someone using an acceptance-commitment orientation will largely inquire about present issues and concerns. 

Regardless of the specific framework, it is important to be working with a therapist who uses evidence-based interventions. This term means that the orientation is supported by research and has proven to help individuals with similar issues. 

Ethically, therapists should only be providing evidence-based intervention. However, this question still helps to provide information about what to expect throughout the process.

For more information on different therapeutic orientations, we recommend the following MedCircle original series:

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4. How do you think therapy can help me?

It is very important for all therapists to explain this concept to each individual. By understanding and truly believing in this process, you will have a better experience and likely see better outcomes.

Therapists are professionally trained to work through a variety of issues and will use multiple different techniques throughout the course of a session. Although you may not know exactly when the techniques are occurring, it is important for clients to have a general understanding of how therapy will be helpful. 

For example, a therapist might say that therapy will help the client by gaining insight and understanding into their interpersonal patterns will help change behaviors, or increasing one’s ability to recognize and alter negative thinking patterns. 

Prior to starting therapy, a lot of people are unsure about this process and do not know what to expect. Additionally, many individuals hold misconceptions about therapy – such assuming the therapist will be “giving advice,” or believing that it is similar to speaking with a friend or loved one. This question can help address some of these beliefs.

If your therapist gives you an answer that is somewhat confusing, ask for clarification or for examples of what this might look like.

5. How should I prepare for sessions?

Therapy requires work inside and outside of sessions. For example, in cognitive behavioral therapy, the work outside of the session is fairly structured and often entails completing worksheets. Alternatively, in an insight-oriented approach, a therapist might simply ask you to bring awareness to your more intense emotions throughout the week and recognize the situation, as well as any relevant thoughts that occur at that time. 

Asking this question at the beginning of the therapy process can be helpful for multiple reasons. First, it will give you an idea about your therapist’s expectations of you outside of session. If you feel as though these expectations are unreasonable or would add additional stress, you should absolutely communicate that, as there may be a way to modify this. Additionally, this question will help you understand how to get the most out of the therapeutic process and ideally, will help it be more successful.

6. How frequently should we meet?

Depending on one’s presenting concerns, stressors, financial considerations, as well as the therapist’s availability, session frequency is something to consider. In most cases, therapists will recommend either weekly or every-other week sessions. 

However, session frequency can certainly change over time. It is not uncommon to start with more frequent sessions and, over time, transition to a less frequent schedule. Alternatively, if an individual notices and increase in symptoms, they might be recommended to pursue more frequent sessions.

Sometimes, due to severity of symptoms, an individual may require multiple sessions per week. It is possible that some outpatient therapists could offer two sessions per week; however, if an individual needs more than that, they will likely be recommended to pursue a higher level of care (e.g., intensive outpatient program, partial hospitalization program).

Discussing session frequency with your therapist will help manage your expectations around this process and will help you understand the progression of treatment over time.

7. Do you think I should consider medication?

For the majority of mental health disorders, a combination of both therapy and medication can yield the best results. 

For example, in the case of depression, medication can help someone “lift” their mood enough to more effectively engage in the therapeutic process. In other words, the medication actually makes the therapy more effective.

Although medication may not be the right plan for everyone, this is a helpful topic to discuss with your therapist. Even though therapists typically do not prescribe medication, they are trained in recognizing when someone may need to pursue both treatment options.

In order to do so, your therapist will assess the severity of your presenting issues, as well as the extent to which these are interfering with your life. This may also be a conversation that occurs after some time. For example, if someone is not responding to therapy in an ideal way, this might be something that your therapist recommends.

If a therapist believes you could be a good candidate for a medication consultation, they should introduce this topic. If your therapist does not introduce this and you are curious about medication, it is recommended that you inquire about this. 

8. How will I know if therapy is working?

This question is really important to ask, as it helps individuals understand the process of therapy and develop realistic expectations. 

This answer will be different depending on one’s presenting concerns, as well as the therapist’s orientation. For example, when working with a cognitive behavioral therapist for anxiety, therapy is “working” when the individual feels more control over their anxiety and can effectively cope with symptoms. Alternatively, when working towards smoking cessation using a motivational interviewing approach, therapy is “working” when the individual feels more intrinsic motivation and confidence about this change. Lastly, if the therapist is coming from a psychodynamic perspective, the success of therapy may be more related to gaining insight and understanding.

Overall, this question helps to identify the potential changes you will see throughout this process.

9. How many sessions do you anticipate it will take to see noticeable improvement?

This question will largely help to manage your expectations about this process. 

Keep in mind that different orientations impact the pace and duration of therapy. For example, motivational interviewing focused on behavior change is a brief intervention that may only require 1-3 appointments. Alternatively, some forms of cognitive-behavioral therapy may require between 12-20 sessions. 

That being said, research has demonstrated that clients might experience some benefit after only a single session. Additionally, on average, approximately 50% of people experience significant improvement by the 8th session of cognitive behavioral therapy.

Overall, this question helps to ensure that your therapist is working from a timeline and has a comprehensive plan. If you have concerns about how therapy is progressing, or if you are not seeing improvement, discuss this with your provider.

10. Could you tell me about your clinic policies related to insurance, cancellations, and no-shows?

The final question to ask a new therapist should be asked once you determine that this provider is a good fit. It is helpful to ask some of these more specific questions about the practice’s policies. In most cases, this is information that your provider will review with you during the first appointment, so you may not need to directly ask about these concepts.

One of the biggest barriers to therapy is its cost; therefore, it will be important to ask about the insurance policies of the practice. Before even choosing a therapist, it is recommended that you contact your insurance company and inquire about your behavioral health coverage (e.g., deductible, co-pays, and co-insurance). When choosing a provider, it is easiest to choose a provider who is paneled, or “in network,” with your health insurance. That way, they will be able to bill your insurance company directly. However, some practitioners choose to not be paneled with any insurance companies. In these scenarios, you will be required to pay in cash up front and can submit claims for an “out of network” provider. In some cases, the provider may help you submit these claims. For more information on navigating health insurance and therapy, this article can be helpful.

It is also helpful to inquire about your therapist’s cancellation and no-show policy. Most therapists have policies related to these factors and this is largely due to the length of the therapy appointment. In most cases, psychotherapy is scheduled for between 45-60 minutes. If a patient no-shows an appointment, the provider is unable to bill insurance companies, since no services were actually provided. Therefore, in some cases, the cost of the appointment might fall on you.

These policies are quite different depending on the practice. Some clinicians will give require 24-hours of notice, while others may require a few days. Additionally, some clinicians may choose to charge the full price of the session for a no-show or late cancellation, while others may charge half or nothing at all. Regardless of the specific policies, it is helpful to know this information at the beginning of treatment, so there are no surprises in the future. 

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Disclaimer: This information is not specific medical advice and does not replace information you receive from your healthcare provider. This is only a brief summary of general information. It does NOT include all information about conditions, illnesses, injuries, tests, procedures, treatments, therapies, discharge instructions or lifestyle choices that may apply to you. You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

You must talk with your health care provider for complete information about your health and treatment options. This information should not be used to decide whether or not to accept your health care provider’s advice, instructions or recommendations. Only your health care provider has the knowledge and training to provide advice that is right for you.

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